New Worker Orientation
Employee Name *
Position *
Date Hired *
Date of Orientation *
Person providing orientation (Name and Positon) *
Company Name *
1. Supervisor name and contact information *
Yes
2. Rights and Responsibilities (a) General Duties of employers, workers and supervisors *
Yes
(b) Worker's right to refuse unsafe work and the procedure for doing so *
Yes
(c) Worker's responsibility to report hazards and the procedure for doing so *
Yes
3.Workplace health and safety rules *
Yes
4. Known hazards in the workplace and how to deal with them *
Yes
5. Safe work procedures for carrying out tasks *
Yes
6. Procedures for working alone or in isolation *
Yes
7. Measures to reduce the risk of vlolence In the situations workplace, and procedures for dealing with violent situations *
Yes
8. Personal protective equipment (PPE) what to use, when to use It, and where to find it *
Yes
9. First ald and Incident reporting (a) First ald attendant name and contact information *
Yes
(b) Locations of first aid kits and eye wash facilitles *
Yes
(c) How to report an Illness, Injury, or Incident (including near misses) *
Yes
Supervisor Name (Printed) *
3. Sign Out Initial *
10. Emergency procedures (a) Locations of emergency exits and meeting points *
Yes
(b) Locations of fire extnguishers and fire alarms *
Yes
(c) How to use fire extinguishers *
Yes
(d) What to do In an emergency *
yes
11. Basic contents of the occupational health and safety program (formal or informal) *
Yes
12. Hazardous materials and WHMIS *
Yes
(a) What hazardous materlals are In the workplace *
Yes
(b) Purpose and significance of hazard Information on product labels *
Yes
(c) Location, purpose, and significance of safety data sheets (SDSs) *
Yes
(d) How to handle, use, store, and dispose of hazardous materials safely *
Yes
(e) Procedures for an emergency InvolvIng hazardous materials, Including clean-up of spills *
Yes
13. Contact Informatlon for the occupational health and safety committee or worker health and safety representative *
Yes
14. Bullying and harassment (a) What Is workplace bullying and harassment *
Yes
(b) How to report Inddents of workplace bullyIng and harassment (e.g., forms, procedures, contact Information) *
Yes
(c) Who Is responsible for following up on complaints *
Yes
(Trainer) Information is correct *
Yes, I Confirm
(Worker) Information is correct *
Yes, I Confirm
Submit